Provider Enrollment Field Representative- Richmond, VA (Hybrid)

Gainwell Technologies LLC•Any city, OH

1d•$56,300 - $80,400•Hybrid

About The Position

The Provider Field Representative serves as the primary liaison between Gainwell Technologies, Virginia Medicaid, and healthcare providers throughout Virginia. The role supports provider enrollment, revalidation, screening, participation, and compliance initiatives, acting as a resource for providers and provider organizations. It involves outreach, provider education, on-site screening activities, inquiry resolution, and relationship building to support program integrity, provider compliance, and access to care for Virginia Medicaid members. The position works directly with physicians, clinics, hospitals, behavioral health providers, long-term care facilities, and other healthcare organizations. The representative conducts in-state site visits for moderate- and high-risk provider enrollments, documents findings, researches provider issues, and collaborates with internal operational and compliance teams. This is a hybrid position based in Richmond, Virginia, with regular travel throughout the Commonwealth. Candidates must reside in Virginia. The schedule is Monday through Friday, 8:00 AM to 5:00 PM CST. Candidates must complete a skills and competency assessment before advancing in the selection process.

Requirements

At least two years of experience in provider enrollment, provider relations, revalidation, Medicaid operations, healthcare administration, credentialing, medical billing, compliance, customer service, or a related healthcare environment.
Experience working directly with physicians, healthcare facilities, behavioral health providers, long-term care providers, or other healthcare organizations.
Knowledge of provider screening requirements and participation standards.
Strong presentation, communication, and relationship-building skills.
Ability to analyze provider issues, identify solutions, and communicate complex information clearly and professionally.
Strong organizational skills and ability to manage multiple priorities and deadlines.
Proficiency with Microsoft Outlook, Excel, Word, Teams, and PowerPoint.
Must reside in Virginia.
Ability to travel throughout Virginia for site visits and outreach activities.
Completion of a skills and competency assessment before advancing to the next stage of selection.

Nice To Haves

Experience conducting provider education, outreach, training, audits, inspections, site visits, or other provider-facing activities.

Responsibilities

Serve as the primary point of contact for providers regarding enrollment, revalidation, participation requirements, credentialing, provider maintenance, and compliance activities.
Conduct proactive outreach about enrollment applications, revalidation requirements, deadlines, corrective actions, and Virginia Medicaid initiatives.
Perform in-state site visits for moderate- and high-risk provider enrollments in accordance with CMS, federal, state, and Virginia Medicaid screening requirements.
Complete site visit documentation, identify potential compliance concerns, and communicate findings according to program policies and procedures.
Research, investigate, and resolve provider inquiries related to enrollment, participation requirements, claims, billing, site visits, and Virginia Medicaid provider operations.
Deliver provider education through webinars, workshops, provider forums, conferences, presentations, and one-on-one consultations.
Build and maintain relationships with healthcare providers, provider associations, community stakeholders, and state partners throughout Virginia.
Monitor provider participation and outreach, identify barriers to enrollment and revalidation completion, and recommend process improvements.
Collaborate with Provider Enrollment, Operations, Quality Assurance, Compliance, Program Integrity, and Client teams to support provider satisfaction and operational excellence.
Document provider interactions, outreach activities, site visits, and issue resolutions in accordance with contract requirements and established procedures.
Support special projects and provider engagement initiatives to improve provider participation, compliance, data quality, and enrollment outcomes.
Serve as a trusted resource to Virginia Medicaid providers throughout the enrollment and participation lifecycle.
Participate in provider-focused meetings, conferences, training events, and stakeholder engagement activities.
Travel throughout Virginia to conduct provider site visits and support provider outreach activities.